The Clinical Study Of Different Frequency Repetitive Transcranial Magnetic Stimulation On Motor Function Recovery In Patients With Stroke

Objective: The morbidity of stroke has been increasing in recent years.As being one of the diseases that has the highest disability rate,the recovery of stroke has received great concern.Hemiplegia is one of the leading disabilities after stroke which directly affects the activity of stroke patients in their daily life.In addition,upper limb dysfunction is usually considered as the difficult point in rehabilitation among other motor disabilities.Repetitive transcranial magnetic stimulation(rTMS),based on the principle of electromagnetic induction,is a technique that stimulates partial and remote area by acting on the magnetic field of specific brain cortex.rTMS takes advantage of repetitive and continuous electromagnetic induction which leads multiple functional areas of the brain to be modulated with cumulative effect.As being an advanced and non-invasive method with the feature of accurate localization,safety and no cross-infection,rTMS has gradually received the concern from the rehabilitation community.So far,rTMS treatment program has not yet reached a consensus.The experiments herein aim to compare the effect of stroke patient's motor function recovery with different frequencies of rTMS combined with conventional rehabilitation training in order to provide the scientific basis of rTMS application.Methods: Eighty-one patients from Department of Rehabilitation Medicine,Hebei General Hospital were enrolled in this study.They were randomly assigned to three groups: low-frequency group(1Hz rTMS to the non-lesion hemisphere M1 area [n=24]),high-frequency group(10Hz rTMS to the lesion hemisphere M1 area [n=31],3 patients withdrew from the experiment group),and sham stimulation group(sham rTMS to the hemisphere M1 area [n=26]).We conducted the rTMS therapy 20 minutesonce in a day.Conventional rehabilitation therapy was performed 70-80 minutes once in a day.Each participant took a course of 10 days in two weeks.Fugl-Meyer Assessment of motor recovery(FMA),The Wolf Motor Function Test(WMFT),Motor Assessment Scale(MAS),Berg Balance Scale(BBS)and Modified Barthel Index(MBI)were measured by all patients before and after 2weeks of treatment.Results:1 The effect of rTMS on motor function after stroke1.1 Upper limb FMA score,WMFT scoreThere was no significant difference between three groups in upper limb FMA scores and WMFT scores before treatment(P>0.05).After treatment,upper limb FMA scores,WMFT scores in two experimental groups were obviously higher than those in control group(P<0.05).The scores in high-frequency group were remarkably higher than low-frequency group(P<0.05).There was a significant increase in upper limb FMA scores and WMFT scores after treatment in three groups respectively(P<0.01);1.2 Lower limb FMA scoreThere was no significant difference between three groups in lower limb FMA scores before treatment(P>0.05).After treatment,lower limb FMA scores in two experimental groups were obviously higher than those in control group(P<0.05).There was no significant difference between high-frequency group and low-frequency group(P>0.05).There was a significant increase in lower limb FMA scores after treatment in three groups respectively(P<0.01);1.3 MAS scoreThere was no significant difference between three groups in MAS scores before and after treatment(P>0.05).Compared with pre-treatment,MAS scores in three groups significant increased after treatment respectively(P<0.01);2 The effect of rTMS on BBS scoreThere was no significant difference between three groups in BBS scores before and after treatment(P>0.05).Compared with pre-treatment,BBSscores in three groups significant increased after treatment respectively(P<0.01);3 The effect of rTMS on Modified Barthel IndexThere was no significant difference between three groups in MBI scores before and after treatment(P>0.05).Compared with pre-treatment,MBI scores in three groups significant increased after treatment respectively(P<0.01).Conclusion:rTMS can promote the recovery and improvement of stroke patient's motor function.High-frequency rTMS(10Hz)is more effective to the recovery of upper limb motor function than low-frequency rTMS(1Hz).